A meta-analysis of percutenous compression plate versus intramedullary nail for treatment of intertrochanteric HIP fractures

• PCCP has advantages over IMN in transfusion requirement, hospital stay, rate of implant-related complications.
• PCCP maintains equivalent functional outcomes and success rates in fracture fixation compared with IMN.
• Future well-designed RCTs are still needed to confirm this conclusion.

IntroductionIntertrochanteric hip fracture is associated with increased morbidity. Currently, a dramatic change in practice was demonstrated, with the intramedullary fixation rate increasing, despite a lack of evidence in the literature supporting the change. As a minimally invasive technique, percutaneous compression plating (PCCP) has been advocated to reduce blood loss, relieve pain, and lead to faster rehabilitation for treatment of intertrochanteric hip fractures. The purpose of this meta-analysis was to estimate the outcomes and complications of the PCCP versus intramedullary nail (IMN) fixation for intertrochanteric fractures.MethodsA comprehensive search of related literature was conducted to identify all articles in Medline, Embase, Scopus, Research Gate, and the Cochrane Central Register of Controlled Trials published on or between January 1998 and January 2016. All studies that compared PCCP with IMN in treating adult patients with intertrochanteric fractures were included. Main outcomes about the two fixation method were collected and analysised using the Review Manager 5.1 provided by The Cochrane Collaboration.ResultsSix trials involving 908 fractures met the inclusion criteria. Compared with IMN, PCCP had similar operation time, intraoperative blood loss, mortality, system complications, function score, function recovery, and reoperation rate (P > 0.05). But hospital stay, transfusion need, and incidence of implant-related complications significantly favored the PCCP (P < 0.05).ConclusionsThe PCCP was associated with less transfusion need, reduced hospital stay, and fewer incidence of implant-related complications compared with IMN. Although a change in practice was occurred, the patients treated with IMN seemed to face the potential for more complications. Owing to the limitations of this systematic review, more high-quality randomized controlled trials (RCTs) are still needed to confirm this conclusion.